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Beneficial Fiber for Crohns Disease Patients

Beneficial Fiber for Crohns Disease Patients

“Inflammatory bowel diseases (IBD) are chronic inflammatory diseases involving potentially the entire gastrointestinal tract. Most often, the onset of IBD is during young adulthood, but in 15-20% of patients the disease starts before their 18th anniversary. Based on clinical, endoscopic, but also immunological and biological parameters, different phenotypes of IBD can be identified. Usually, the presence of granulomatous lesions and/or the involvement of the small bowel with typical ulcerations orientate towards the diagnosis of Crohn’s disease (CD), while isolated continuous colonic involvement is in favor of ulcerative colitis (UC). The recent modification of the Porto criteria for the diagnosis of pediatric IBD provides a helpful tool in the diagnostic workup and classification of children/adolescents with IBD. When discussing different treatment options for IBD, it is important to consider pathophysiological aspects and differences and to base therapy whenever possible on pathophysiological mechanisms. This approach will allow going beyond symptomatic therapy, yet is still important to relief symptoms, but most often not appropriate to change the course of a chronic disease. Indeed, IBD are chronic inflammatory diseases with a tendency to cause intestinal damage, especially when the disorder starts early in life, i.e. childhood or adolescence. Thus, treatment strategies aim to control this chronic inflammatory process and are mainly based on immunosuppressive agents; however, there are clear indicators that nutritional interventions might also play an important role in controlling IBD.”1 

“In distinction, CD (Crohn’s Disease) can involve any part of the GI tract and can present in a penetrating (fistulizing), fibrostenotic (stricturing), or inflammatory pattern, and usually has a clinical presentation of diarrhea, abdominal pain, and malnutrition. Surgical resection of the affected bowel segments is a short-term solution that is rarely curative and in the long run can lead to detrimental complications such as short gut syndrome and total parenteral nutrition (TPN) dependency. Evaluative tools that can assess proximal segments of the small bowel that are beyond the reach of standard ileocolonoscopy are important and can provide optimal assessments that are vital in taking the decision of proceeding with surgery. As endoscopic assessment can be associated with complications related to sedation or colonic perforation, noninvasive methods to detect disease activity are needed. Furthermore, both UC (ulcerative colitis) and CD are associated with a wide range of extraintestinal manifestations such as sclerosing cholangitis, spondyloarthropathy, and metabolic bone disease, which ideally should be handled by specialized physicians. Additionally, novel drugs that have been proven effective and safe in treating UC and CD are being introduced as a replacement or complement for conventional therapies that are either ineffective or known to be associated with adverse events. Collectively, these clinical aspects of IBD (inflammatory bowel disease) suggest that advances in continuous and comprehensive care for IBD patients are necessary. However, whether these advancements would impact the overall outcome of IBD patients remains unclear.”2 

Most patients with Crohn’s Disease (CD) have a hard time when it comes to eating because many foods can trigger their CD symptoms. It has always been known that fiber helps and benefits CD patients, but some of them find fiber difficult to digest and sometimes it worsens their symptoms.

“Dietary fiber intake provides many health benefits. A generous intake of dietary fiber reduces risk for developing the following diseases: coronary heart disease, stroke, hypertension, diabetes, obesity, and certain gastrointestinal disorders. Furthermore, increased consumption of dietary fiber improves serum lipid concentrations,7 lowers blood pressure, improves blood glucose control in diabetes, promotes regularity, aids in weight loss, and appears to improve immune function. Unfortunately, most persons in the United States consume less than half of the recommended levels of dietary fiber daily. This results from suboptimal intake of whole‐grain foods, vegetables, fruits, legumes, and nuts. Dietary fiber supplements have the potential to play an adjunctive role in offering the health benefits provided by high‐fiber foods.“

“Dietary fiber has been investigated as a means of increasing short-chain fatty acid (SCFA) production. IBD (inflammatory bowel disease) has been linked with impaired SCFA production. SCFAs are mainly produced by the anaerobic bacterial fermentation of undigested carbohydrates and fiber polysaccharides. In 1995, Galvez et al reviewed a number of studies that concluded that dietary fiber confers clinical benefits in patients with IBD because it maintains remission and reduces colonic damage. This is thought to occur by increasing SCFA production and by altering the gut flora towards predominantly non-pathogenic bacteria.”4  

Even though fiber has many benefits like helping normalize bowel movements, not all types of fiber are favorable for Crohn’s Disease patients. New studies have shown that a diet rich in soluble fruit fibers is the most beneficial for preventing CD and flare-ups.

Fiber is a kind of carbohydrate that passes through the body undigested. Most carbohydrates are separated and fragmented into sugar molecules but fiber cannot be fragmented into sugar molecules. Fibers (plant-based) helps control our blood sugar and appetite, and also regulate our body’s sugar use. 

“Dietary fiber is known to 1) improve laxation by increasing bulk and reducing transit time of feces through the bowel; 2) increase excretion of bile acid, estrogen, and fecal procarcinogens and carcinogens by binding to them; 3) lower serum cholesterol; 4)  slow glucose absorption and improve insulin sensitivity; 5) lower blood pressure; 6) promote weight loss; 7) inhibit lipid peroxidation; and 8) provide anti-inflammatory properties. After a large prospective cohort study, Park et al found that dietary fiber intake was significantly inversely associated with risk of total death and death from cardiovascular disease, infectious diseases, and respiratory diseases in both men and women. Dietary fiber intake was also related to a lower risk of death from cancer in men. Among specific sources of dietary fiber, fiber from grains showed the most consistent inverse association with risk of total and cause-specific death. Namely, current chronic diseases are related to decreased consumption of dietary fiber—which is a part of dietary Westernization. In evaluating the effects of dietary Westernization we are apt to stress adverse effects of increased consumption of animal protein or animal fat, but it is equally important to stress the drawbacks of decreased consumption of dietary fiber.”5 

 

Dietary fiber and its effect on and relationship to chronic diseases
Dietary fiber and its effect on and relationship to chronic diseases. High Amount of Dietary Fiber Not Harmful But Favorable for Crohn Disease. Chiba, M., Tsuji, T., Nakane, K. & Komatsu, M. The Permanente Journal. 2015.

 

“Inflammatory bowel diseases (IBD) are chronic inflammatory diseases involving potentially the entire gastrointestinal tract. Most often, the onset of IBD is during young adulthood, but in 15-20% of patients the disease starts before their 18th anniversary. Based on clinical, endoscopic, but also immunological and biological parameters, different phenotypes of IBD can be identified. Usually, the presence of granulomatous lesions and/or the involvement of the small bowel with typical ulcerations orientate towards the diagnosis of Crohn’s disease (CD), while isolated continuous colonic involvement is in favor of ulcerative colitis (UC). The recent modification of the Porto criteria for the diagnosis of pediatric IBD provides a helpful tool in the diagnostic workup and classification of children/adolescents with IBD. When discussing different treatment options for IBD, it is important to consider pathophysiological aspects and differences and to base therapy whenever possible on pathophysiological mechanisms. This approach will allow going beyond symptomatic therapy, yet is still important to relief symptoms, but most often not appropriate to change the course of a chronic disease. Indeed, IBD are chronic inflammatory diseases with a tendency to cause intestinal damage, especially when the disorder starts early in life, i.e. childhood or adolescence. Thus, treatment strategies aim to control this chronic inflammatory process and are mainly based on immunosuppressive agents; however, there are clear indicators that nutritional interventions might also play an important role in controlling IBD.”1 

“In distinction, CD (Crohn’s Disease) can involve any part of the GI tract and can present in a penetrating (fistulizing), fibrostenotic (stricturing), or inflammatory pattern, and usually has a clinical presentation of diarrhea, abdominal pain, and malnutrition. Surgical resection of the affected bowel segments is a short-term solution that is rarely curative and in the long run can lead to detrimental complications such as short gut syndrome and total parenteral nutrition (TPN) dependency. Evaluative tools that can assess proximal segments of the small bowel that are beyond the reach of standard ileocolonoscopy are important and can provide optimal assessments that are vital in taking the decision of proceeding with surgery. As endoscopic assessment can be associated with complications related to sedation or colonic perforation, noninvasive methods to detect disease activity are needed. Furthermore, both UC (ulcerative colitis) and CD are associated with a wide range of extraintestinal manifestations such as sclerosing cholangitis, spondyloarthropathy, and metabolic bone disease, which ideally should be handled by specialized physicians. Additionally, novel drugs that have been proven effective and safe in treating UC and CD are being introduced as a replacement or complement for conventional therapies that are either ineffective or known to be associated with adverse events. Collectively, these clinical aspects of IBD (inflammatory bowel disease) suggest that advances in continuous and comprehensive care for IBD patients are necessary. However, whether these advancements would impact the overall outcome of IBD patients remains unclear.”2 

Most patients with Crohn’s Disease (CD) have a hard time when it comes to eating because many foods can trigger their CD symptoms. It has always been known that fiber helps and benefits CD patients, but some of them find fiber difficult to digest and sometimes it worsens their symptoms.

“Dietary fiber intake provides many health benefits. A generous intake of dietary fiber reduces risk for developing the following diseases: coronary heart disease, stroke, hypertension, diabetes, obesity, and certain gastrointestinal disorders. Furthermore, increased consumption of dietary fiber improves serum lipid concentrations,7 lowers blood pressure, improves blood glucose control in diabetes, promotes regularity, aids in weight loss, and appears to improve immune function. Unfortunately, most persons in the United States consume less than half of the recommended levels of dietary fiber daily. This results from suboptimal intake of whole‐grain foods, vegetables, fruits, legumes, and nuts. Dietary fiber supplements have the potential to play an adjunctive role in offering the health benefits provided by high‐fiber foods.“

“Dietary fiber has been investigated as a means of increasing short-chain fatty acid (SCFA) production. IBD (inflammatory bowel disease) has been linked with impaired SCFA production. SCFAs are mainly produced by the anaerobic bacterial fermentation of undigested carbohydrates and fiber polysaccharides. In 1995, Galvez et al reviewed a number of studies that concluded that dietary fiber confers clinical benefits in patients with IBD because it maintains remission and reduces colonic damage. This is thought to occur by increasing SCFA production and by altering the gut flora towards predominantly non-pathogenic bacteria.”4  

Even though fiber has many benefits like helping normalize bowel movements, not all types of fiber are favorable for Crohn’s Disease patients. New studies have shown that a diet rich in soluble fruit fibers is the most beneficial for preventing CD and flare-ups.

Fiber is a kind of carbohydrate that passes through the body undigested. Most carbohydrates are separated and fragmented into sugar molecules but fiber cannot be fragmented into sugar molecules. Fibers (plant-based) helps control our blood sugar and appetite, and also regulate our body’s sugar use. 

“Dietary fiber is known to 1) improve laxation by increasing bulk and reducing transit time of feces through the bowel; 2) increase excretion of bile acid, estrogen, and fecal procarcinogens and carcinogens by binding to them; 3) lower serum cholesterol; 4)  slow glucose absorption and improve insulin sensitivity; 5) lower blood pressure; 6) promote weight loss; 7) inhibit lipid peroxidation; and 8) provide anti-inflammatory properties. After a large prospective cohort study, Park et al found that dietary fiber intake was significantly inversely associated with risk of total death and death from cardiovascular disease, infectious diseases, and respiratory diseases in both men and women. Dietary fiber intake was also related to a lower risk of death from cancer in men. Among specific sources of dietary fiber, fiber from grains showed the most consistent inverse association with risk of total and cause-specific death. Namely, current chronic diseases are related to decreased consumption of dietary fiber—which is a part of dietary Westernization. In evaluating the effects of dietary Westernization we are apt to stress adverse effects of increased consumption of animal protein or animal fat, but it is equally important to stress the drawbacks of decreased consumption of dietary fiber.”5 

 

Benefits of Dietary Fiber Intake and effects on the gut microbiota
Benefits of Dietary Fiber Intake and effects on the gut microbiota.
Potential Benefits of Dietary Fiber Intervention in Inflammatory Bowel Disease. Wong, C., Harris, P.J. & Ferguson, L.R. International Journal of Molecular Science. 2016.

 

“Dietary fibers affect the entire gastrointestinal tract from the mouth to the anus. High-fiber foods usually have lower energy density and take longer to eat. Soluble fibers usually delay gastric emptying. Soluble fibers may act to slow transit of food materials through the small intestine while insoluble fibers tend to create “intestinal hurry”. In the small intestine, dietary fibers can elicit responses of a wide variety of gastrointestinal hormones that serve as incretins to stimulate insulin release and affect appetite. Some fibers bind bile acids and impede micelle formation, thus increasing fecal excretion of bile acids and cholesterol.56 In the colon, fermentable fibers increase bacterial mass with some acting as prebiotics to promote health-promoting bacteria such as lactobacilli and bifidobacteria. Insoluble fibers are especially effective in increasing fecal mass and promoting regularity.”6

Researchers’ studies have concluded that soluble fiber, more specifically soluble fruit fibers, helps prevent or reduce the risk of developing Crohn’s Disease (CD).

”The possible roles of dietary fibers (DFs) in the etiology of CD (Crohn’s Disease) and UC (ulcerative colitis) are unclear. Diets low in DF (low residue diets) are sometimes recommended to patients with the active forms of the diseases, while recommendations for patients with the inactive forms have usually not considered dietary fiber, partly because individuals differ in dietary tolerances and intolerances. Different types of DF have different properties and health effects in diseases such as IBD. Potential benefits include reducing diarrhea or constipation, producing short-chain fatty acids (SCFAs), down-regulating inflammation, promoting tissue healing, and by these means potentially preventing the onset of colorectal cancer (CRC) in susceptible IBD patients.”7 

“Although the precise mechanism is to be determined, epidemiology provides convincing evidence that a plant-based diet is a healthy diet providing therapeutic and/or preventive effects against current major chronic diseases. Available data suggest the rationale to use dietary fiber in the treatment of IBD (Inflammatory bowel diseases). We believe a plant-based diet not only is effective for gut inflammation but also promotes the general health of IBD patients. A plant-based diet inevitably contains considerable amounts of dietary fiber. A high amount of dietary fiber is not harmful and seems to be favorable for CD.”

 

References 

(1) Role of Diet in Inflammatory Bowel Disease. Ruemmele, F.M. Annals of Nutrition & Metabolism. 2016. https://www.karger.com/Article/FullText/445392 

(2) Advances in the Diagnosis and Management of Inflammatory Bowel Disease: Challenges and Uncertainties. Mosli, M., Beshir, M.A., Al-Judaibi, B., Al-Ameel, T., Saleem, A., Bessissow, T., Ghosh, S., & Almadi, M. The Saudi Journal Of Gastroenterology. 2014. http://www.saudijgastro.com/article.asp?issn=1319-3767;year=2014;volume=20;issue=2;spage=81;epage=101;aulast=Mosli 

(3, 6) Health benefits of dietary fiber. Anderson, J.W. Baird, P., Davis, R.H., Ferreri, S., Knudtson, M., Koraym, A.,  Waters, V. & Williams, C.L. Nutrition Reviews. 2009. https://onlinelibrary.wiley.com/doi/full/10.1111/j.1753-4887.2009.00189.x 

(4) Role of diet in the management of inflammatory bowel disease. Rajendran, N. & Kumar, D. World Journal Of Gastroenterology . 2010. https://www.wjgnet.com/1007-9327/full/v16/i12/1442.htm 

(5, 8)High Amount of Dietary Fiber Not Harmful But Favorable for Crohn Disease. Chiba, M., Tsuji, T., Nakane, K. & Komatsu, M. The Permanente Journal. 2015. http://www.thepermanentejournal.org/issues/2015/winter/5802-crohns-disease.html 

(7)Potential Benefits of Dietary Fibre Intervention in Inflammatory Bowel Disease. Wong, C.,  Harris, P.J. & Ferguson, L.R. International Journal of Molecular Science. 2016. https://www.mdpi.com/1422-0067/17/6/919/htm 

 

 

María Laura Márquez
13 October, 2018

Written by

María Laura Márquez, general doctor graduated from The University of Oriente in 2018, Venezuela. My interests in the world of medicine and science, are focused on surgery and its breakthroughs. Nowadays I practice my profession...read more: